Summary & Overview
CPT 19325: Breast Augmentation by Implant Placement
Headline: CPT code 19325: Breast augmentation by implant placement — national billing overview
Lead: CPT code 19325 designates surgical breast augmentation where an implant is placed to increase breast size and volume. The code is widely used across cosmetic and reconstructive practices and carries significance for payer coverage, facility billing, and surgical service-line planning.
What the code represents and why it matters: CPT code 19325 identifies a commonly performed elective and reconstructive procedure that affects practice revenue, prior authorization workflows, and benefit design. Nationally, its prevalence influences contracted rates, facility utilization, and surgical staffing needs.
Key payers covered: This overview addresses coverage and billing considerations relevant to Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: Readers will get a concise summary of clinical context, typical sites of service, common billing practices, and where to look for benchmarks and policy updates. The publication highlights payer coverage patterns, typical facility and professional billing distinctions, and areas where policy updates commonly arise (for example, medical necessity criteria and network prior authorization requirements).
Scope: Content is national in scope and intended for administrators, coders, and clinicians involved with surgical breast augmentation billing and reimbursement.
Billing Code Overview
CPT code 19325 describes a surgical procedure in which the provider increases the size and volume of the breast by placing a breast implant. This procedure is classified as a breast augmentation with implant placement.
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Service type: Surgical cosmetic/reconstructive procedure to augment breast volume
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Typical site of service: Outpatient surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a healthy adult presenting for elective breast augmentation to increase breast size and volume using silicone or saline implants. The workflow begins with a preoperative consultation documenting cosmetic goals, medical history, informed consent, and selection of implant type, size, and incision approach. Preoperative evaluation includes standard pre-op testing, anesthesia assessment, and marking of surgical sites. On the day of surgery, the patient undergoes general anesthesia in an ambulatory surgery center or hospital outpatient department. The surgeon creates the chosen pocket (subglandular, submuscular, or dual plane), places the implant, achieves hemostasis, and closes incisions. Postoperative care includes recovery room monitoring, discharge with wound care instructions and activity restrictions, and scheduled follow-up visits for incision check and implant position assessment. Typical sites of service are an ambulatory surgery center or hospital outpatient department. This procedure is elective and commonly performed by board-certified plastic surgeons or aesthetic breast surgeons.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default or unspecified modifier | Rarely used; reserved when no other modifier applies |
11 |